Embolization of cerebral arteriovenous malformations with n-butyl-2-cyanoacrylate.

PURPOSE: To determine the safety and effectiveness of arteriovenous malformation (AVM) embolization using liquid adhesives in a series of 103 patients with cerebral AVMs who underwent embolization with n-butyl-2-cyanoacrylate (NBCA). METHODS: All embolization procedures were performed using NBCA and a lipiodol mixture delivered by a flow-directed and/or guide-wire directed microcatheter. RESULTS: Using the Spetzler-Martin grading system, there were two cases of grade I AVM, 23 of grade II AVM, 31 of grade III AVM, 37 of grade IV AVM, and 10 of grade V AVM. Eleven patients underwent embolization only; these patients either had evidence of morphologic cure on follow-up angiogram, or showed evidence of a stable condition at 2-years follow-up. Seven patients were not treated owing to technical problems or a positive functional test. All other patients underwent preoperative embolization; 75%-99% obliteration was noted in 39 of these patients, 50%-74% obliteration in 33, and less than 50% obliteration in 13. Embolization-related complications occurred in nine patients, and two patients died as a result of the procedure. Severe neurologic complications occurred in two patients and five patients developed mild or transient neurologic deficit. CONCLUSIONS: Endovascular treatment of brain AVMs with an NBCA mixture has a lower complication rate than shown in previous studies using other materials. The percentage of obliteration of the nidus is increased because NBCA penetrates AVMs better than polyvinyl alcohol particles. NBCA can be used at a lower concentration than other acrylates, and therefore causes almost no catheter gluing. The embolic mass formed by NBCA is more biocompatable than that formed by other acrylates.